Ayurveda; safety, effectiveness, and acceptance around the world

1.1 What is Ayurveda?

Ayurveda, generally understood as “the science of life,” connotes an ancient holistic body care system developed from ancient Indian traditions. It denotes the interrelationship between mind, body, and soul. It covers the philosophy of preventing the incidence of diseases by attempting to maintain harmony in all spheres rather than seeking mere symptomatic treatment (Junaid et al., 2017). The concept of Ayurveda is essentially based on the theory of Prakriti, or individual constitution, and it regulates all the physiological and psychological aspects of human health. The three basic doshas are vata, or air and space; pitta, constituted of fire and water elements; and kapha, with water and earth elements. These energies in the human body are needed to keep their functions running well. Imbalances in these doses are believed to be the root cause of this disease (Mukherjee et al., 2017).

The treatments in Ayurveda have been highly individualized in nature, considering that the structure of Prakriti is unique to every individual. The general approach to the healing process includes therapies involving Panchakarma, a detoxifying regimen aimed at cleaning the body through five primary actions: emesis, purgation, and enema (Debnath et al., 2017). Other components of Ayurvedic practice include herbal medicine, dietary adjustments, yoga, meditation, and lifestyle modifications to restore balance and generally improve the well-being of an individual’s life (Sharma & Kumar, 2023).

The philosophical underpinning of Ayurveda surpasses physical health; it places great emphasis on structuring human life in time with nature’s rhythms. This is believed to promote longevity and spiritual growth, thus distinguishing Ayurveda from symptom-centric modern biomedicine (Balkrishna et al., 2024). Ayurveda treats the illness’s root cause, making the health solution sustainable and non-recurring.

1.2 History of Ayurveda

Ayurveda has a history of over 5000 years, and its inception is chronicled in various sets of ancient Indian literature, including Charaka Samhita and Sushruta Samhita. These fundamental scriptures outline principles related to anatomy, pathology, and therapeutics, furthering their advanced medical understanding at that time (Hardiman, 2009). While the Charaka Samhita was mainly confined to internal medicine, the Sushruta Samhita is famous for its surgery-related information, with detailed descriptions of various operations, such as rhinoplasty, which were performed with great precision (Banerjee et al., 2019).

Ayurveda was patronized by Indian rulers in the early centuries and passed through interactions with Buddhist and Persian medical traditions. The medieval period expanded knowledge by including alchemical practices added to Ayurveda’s pharmacological repertoire (Minhas, 2020). Thus, with the advent of colonial rule in India, Ayurveda fell into relative insignificance, as allopathy was imposed as the dominant system of medicine under British rule (Currie, 2005).

Hence, due to the Indian independence movement and the urge for cultural identity, interest in Ayurveda reawakened in the late 19th and early 20th centuries. It owes much to pioneers such as Mahatma Gandhi and Swami Vivekananda for its revitalization in modern times. Standardization regarding Ayurvedic education and practice post-independence led India to develop a regulatory framework to introduce this into mainstream healthcare (Mukherjee et al., 2017).

From a global perspective, Ayurveda has gained recognition as a complementary and alternative medical system. The WHO, among other bodies of the world, is already at the forefront of its implementation. The United States, Germany, and Australia, among others, have considered Ayurvedic science as part of their wellness and healthcare industries, reflecting its universal appeal (Patwardhan, 2005). Krishna et al. (2020) attest that this historical trajectory indicates how adaptable Ayurveda is, making it relevant to today’s health challenges.

1.3 Epidemiology of Ayurveda

In the last few decades, the use of Ayurveda has increased remarkably globally owing to the growing need for natural health remedies and holistic views of healthcare. Ayurveda retains a firm hold in modern India as the mainstream institution, backed by an adequately established framework known as the Ministry of AYUSH: Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. The Ministry is heavily promoting research and development programs since it feels that the ancient branch of science would play an important role in solving modern lifestyle disorders in modern days (Mukherjee et al., 2017).

In the United States, Ayurveda is increasingly being used in various complementary and alternative medicine practices. Recent systematic reviews have reported the beneficial effects of Ayurvedic therapies in managing conditions such as type 2 diabetes mellitus and arthritis, pointing out their safety and efficacy from systematic reviews (Katara and Sawarkar, 2022). Other regulatory bodies, such as the National Center for Complementary and Integrative Health, have also encouraged research on Ayurvedic interventions, thereby widening their acceptance in Western healthcare systems (Banerjee et al., 2019).

Europe is diverse; countries such as Germany and Switzerland hold Ayurveda in extremely high regard and are far more accepting of it as an alternative to their method of healthcare. Countries such as Germany and France allow for various training schools in Ayurveda that house clinics for treatments such as herbal remedies and different forms of Panchakarma therapies. However, owing to the absence of a uniform regulation policy, progress across land remains entirely restricted (Krishna et al., 2020).

Ayurveda has been increasingly appreciated in the Middle East, especially in Arabic Gulf countries such as the United Arab Emirates, Qatar, and Oman. Cultural receptiveness towards traditional and herbal medicines facilitated the passage of Ayurvedic practice, but regulatory hurdles were the main obstacles to this method. This inspired the Saudi National Center of Complementary and Alternative Medicine (NCCAM) concerning Ayurvedic Medicine, for which one or more steps have been put forward with the view to promote safe and qualitative use (Qureshi et al., 2020).

Indeed, there is emerging evidence for the global relevance of Ayurveda, supported by various studies indicating that this traditional knowledge helps manage many chronic diseases and improves the quality of life (Leonti & Casu, 2013). However, the disparities in research and regulation indicate the need for a harmonized effort towards the safe and effective integration of Ayurveda into mainstream healthcare systems.

2.1 Type of research

This study aimed to determine whether Ayurveda is safe and effective in modern health systems worldwide. A literature review approach was adopted to systematically review the existing body of literature on the effectiveness and safety of Ayurveda in contemporary healthcare systems worldwide, thereby allowing evidence synthesis from a diverse range of geographical and cultural contexts. This review article discusses the scientific basis of Ayurveda, particularly in relation to its efficacy in treating chronic diseases, its role in preventive care, and potential safety concerns associated with herbal medicines and detoxification therapies, based on an analysis of peer-reviewed articles, systematic reviews, and meta-analyses.

The literature review focused on high-quality studies published in reputed journals, ensuring the credibility and relevance of the findings to the research objectives. In addition, regulatory frameworks, clinical guidelines, and reports from healthcare institutions were reviewed to understand the integration of Ayurveda in different parts of the world.

2.2 Keywords and search strategy

A detailed search strategy for identifying relevant studies was developed with carefully identified keywords and phrases related to Ayurveda, safety, and effectiveness. The specific searches were refined by the Boolean operators “AND,” “OR,” and “NOT,” which were used as required to limit the volume of literature to only those most relevant. The key phrases used included the following.

An iterative search was performed by adapting the best keyword combinations to reflect the most comprehensive set of relevant articles. Advanced filters were applied, such as specifying publication date, language, and access to full-text articles, to ensure precision in the articles’ relevance.

2.3 Period of search

Literature published between 1999 and 2024 was considered to capture current progress and standpoints on Ayurveda, including the most updated evidence and views. Only studies older than this were excluded, except if they were considered fundamental to the research objectives historically or conceptually.

2.4 Types of references

This study prioritized full-text and peer-reviewed journal articles to maintain academic rigor and reliability. Including relevant abstracts was allowed when full texts were not available, provided the abstracts contained essential insights into the safety or effectiveness of Ayurveda. In addition to peer-reviewed articles, systematic reviews, meta-analyses, and case studies will be included in this literature review to provide broad coverage of the topic. A literature review from globally renowned health institutions, such as the WHO and guidelines from the Ministry of AYUSH, was also conducted to present the findings in a global and national policy context.

2.5 Databases searched

The search was conducted across high-quality academic databases to ensure its completion. The databases included:

These databases were selected because they are considered among the most reputable services of academic and clinical investigation; by searching these databases, relevant peer-reviewed materials will indeed be found. Additional searches were also conducted using Google Scholar, Grey Literature, conference proceedings, and institutional reports.

3.1 India: The Home of Ayurveda

Although many diseases are prevalent in India, the birthplace, and home to the global hub, a large part of science deals with cultural and spiritual aspects and healthcare is traditional. Ayurvedic practices are one of the nation’s primary healthcare mechanisms under the AYUSH government ministerial department (Katoch et al., 2017). It plays a vital role in acute and persistent diseases and is combined with modern medicines throughout many healthcare facilities to enable a complementary approach towards disorders, disease prevention, and the implementation of therapeutic interventions (Mukherjee et al., 2017).

Government initiatives have given Ayurveda much recognition. Programs like the National AYUSH Mission aim to integrate it into primary health care, while research councils and academic institutions, such as the Central Council for Research in Ayurvedic Sciences, advance the scientific validation of its practices (Jain & Sharma, 2014). Interventions from Ayurveda, such as Panchakarma and herbal therapies, have been widely studied for their safety and efficacy. According to a study conducted by Ahlawat and Ohlan in 2024, Panchakarma may help detoxify the body and reduce symptoms associated with chronic diseases such as arthritis and metabolic disorders.

The regulatory framework in India has been strong enough to ensure the quality and safety of Ayurvedic medicines. The Drugs and Cosmetics Act has enforced strict standards in the manufacturing process of Ayurvedic products, so that there is no chance of contamination, adulteration, or even heavy metal toxicity (Patwardhan et al., 2017). This system dispelled many myths about Ayurvedic safety and helped instill world trust in its practices.

However, despite this strong foothold, Ayurveda in India still faces challenges on the road to better scientific validation through large-scale clinical trials and improved accessibility in rural areas. Simultaneously, its holistic philosophy, cost-effectiveness, and adaptability make it a vital component of India’s healthcare ecosystem and an increasingly popular choice for global health-seekers.

3.2 United States

Ayurveda has gained recognition in the United States as an important component of CAM. Its popularity has gained momentum over the last 30 years, driven by increased public interest in holistic and naturalist health practices. Practices associated with Ayurveda, including yoga, meditation, and herbal treatments, have become mainstream in managing stress, improving mental health, and addressing chronic conditions (Sharma, et al., 2023).

As mentioned in the paper, the system faces specific regulatory challenges in allowing full integration into mainstream US healthcare provision. According to the Food and Drug Administration, Ayurveda products are regarded as dietary supplements, not drugs; therefore, they are not subjected to strict pre-market evaluations for possible safety, efficiency, and quality before entering the market, as any pharmaceutical drug is (Madhavan, 2017). The latter presents both positive and negative views: the regulatory framework promotes greater accessibility but raises red flags on product quality and consistency.

On the other side, Ayurveda is commanding increasing credibility through scientific research studies. Researchers in the US have shown that Ayurvedic therapies hold promise for the treatment of diabetes, cardiovascular diseases, and chronic pain. A study on herbal formulations, including Ashwagandha and Turmeric, found anti-inflammatory and adaptogenic properties helpful as safer alternative medications to established ones, thus constituting research outcomes (Tiwari, et al., 2018). Organizations such as the National Center for Complementary and Integrative Health support the practice of Ayurveda by funding different research and education programs to investigate the possible benefits of Ayurveda.

With its integration into the US healthcare system still in its infancy, the increasing demand for natural and holistic therapies presents the next best avenue for expansion. Normalizing Ayurveda practices and developing regulatory frameworks may also nurture growth.

3.3 European Countries

In Europe, the acceptance and integration of Ayurveda vary significantly from country to country. Germany and Switzerland have promoted Ayurveda by integrating the practice into wellness centers, spas, and clinical settings. To date, these countries have gone so far as established training programs for health professionals in Ayurveda to ensure competency and quality in the therapies delivered (Krishna et al., 2020).

Scientific validation of Ayurveda in Europe primarily focuses on its safety and efficacy. For example, studies conducted in Germany have highlighted the potential of Ayurvedic herbal medicines to manage diseases related to rheumatoid arthritis and irritable bowel syndrome (Joos et al., 2006). Various Panchakarma therapies have also maintained their popularity as detoxifying and rejuvenating therapies for people who avoid invasive treatment.

Despite these developments, Ayurveda has not been fully integrated into the European national healthcare systems for some reason. Some regulatory barriers include strict herbal product registration requirements and different health policies that discourage the wide adoption of therapy (Hossain et al., 2022). Several setbacks have been surmounted through public awareness and education on therapy, coupled with a growing interest in alternative therapies for chronic and lifestyle diseases.

In countries such as the United Kingdom, Ayurveda is considered mainly in private circles or settings, wellness tourism, or health-related services, which are considered niches. Although few studies have been conducted in the UK, evidence of its role in quality of life and stress disorders has been established by Sharma and Kumar (2023). The flourishing scenario in Europe speaks much to the fact that Ayurveda addresses potential healthcare gaps as long as regulatory hurdles and changing public perceptions improve.

3.4 Middle Eastern Countries

Ayurveda has started gaining pace in the Middle East, especially in countries such as the UAE and Oman. Traditional and herbal medicines represent cultural importance in the region, constituting a good atmosphere for Ayurveda’s introduction and growth (Mukherjee and Wahile, 2006). NCCAM in Saudi Arabia has given much concederation to Ayurveda since its potential has been found helpful in curing the growing number of cases of chronic and lifestyle diseases, such as diabetes, hypertension, and obesity.

Several factors have curtailed the adoption of Ayurveda in the Middle East. First, the regulatory frameworks governing the practice of traditional medicine remain nascent, and, as such, product quality and safety vary widely. The limited number of trained Ayurvedic practitioners further restricts accessibility. According to Madhavan (2017), collaboration with Indian institutions has resulted in training programs for local practitioners, thereby attempting to bridge the gap in skills.

Various studies conducted in this region have indicated the potential of Ayurveda to improve metabolic health, reduce stress, and improve general well-being. For example, there is a high demand for herbal formulations such as Triphala and Neem in Saudi Arabia owing to their anti-inflammatory and detoxifying properties. Many wellness centers in the UAE have added Panchakarma therapies to attract health tourists (Qureshi et al., 2020).

3.5 Other Countries

The adoption of Ayurveda is increasing beyond the traditional markets of Australia, Southeast Asia, and Africa. In Australia, it is considered a complementary therapy, and an increasing number of practitioners offer Ayurvedic consultation, herbal medication, and pachakarma therapy. Regulatory bodies ensure that Ayurveda practices meet the strict safety and quality standards required; hence, people trust their efficiency (Krishna et al., 2020).

Ayurveda has attained deep roots in the health structure in Southeast Asia, especially in Sri Lanka and Nepal. Ayurvedic treatment in Sri Lanka takes on a national character with some modifications to the traditional Indian system by including indigenous herbs. Ayurvedic treatment is relatively inexpensive, and in addition to local patients, many foreigners flock to Sri Lankan Ayurvedic hospitals and clinics (Kathmandu, 2011). Local research in the region shows that several successes have been achieved in tropical disease management, improvement of maternal health, and general wellness through Ayurveda.

In African countries, Ayurveda is less established, but is gaining its foothold through wellness tourism and with the help of practitioners from India. Herbal formulations are popular because of their relatively low cost and accessibility in resource-poor settings.

3.6 Comparative analysis for safety and effectiveness of Ayurveda

The focus and adoption of research related to Ayurveda varies greatly from region to region. Common focus areas for Ayurveda research were chronic diseases (35%), herbal safety (25%), Panchakarma (20%), regulations (10%), and wellness (10%).

According to the data in Table 1, India is at the frontline in carrying out research related to the safety of practices and Ayurvedic formulation because of its clear regulatory framework coupled with the government-supported programs offered by the Ministry of AYUSH. The nations with high output include the United States and Germany; therefore, most of their studies in Ayurveda relate to either dietary supplements or studies on the efficacy of plants. Countries such as Saudi Arabia and Australia have much more minimal output, which corresponds to their adoption of practices related to herbal medicines rather than Ayurveda (Mukherjee et al., 2017; Banerjee et al., 2019; Qureshi et al., 2020).

Regarding the effectiveness of Ayurveda interventions ( Table 2), India again gained the highest score for evidence showing a wide variety regarding the research of chronic ailments and herbal treatments. Of these countries, the US and Germany ranked high, concentrating their studies on chronic diseases and/or prevention. Sri Lanka’s and Australia’s fields reflect the regional context, which is that of a state prone to tropical diseases and stress management (Katara & Sawarkar 2022; Krishna et al., 2020; Madhavan, 2017).

4.1 Interpretation of findings

The results of this review emphasize the global relevance and growing use of Ayurveda in the healthcare system. The emerging trends in safety and effectiveness data show that Ayurveda plays a dual role in managing chronic diseases and promoting preventive health. Research from high-output countries, such as India, the United States, and Germany, presents substantial progress regarding efficacy and safety validation through Ayurvedic interventions.

4.1.1 Safety and effectiveness across regions

Owing to Ayurveda’s good and deep integration into India’s health system, large-scale clinical trials and observational studies have become practical in the country. The evidence is immense for the safety of traditional practices such as Panchakarma and herbal formulations, such as Triphala and Ashwagandha, which display minimal adverse effects if administered under professional auspices (Mukherjee et al., 2017). Similarly, quality assurance and safety are considerably developed with relevant Indian regulatory frameworks, especially when it involves certification through API, that is, the Ayurveda Pharmacopeia of India.

The acceptance of Ayurveda in complementary and alternative medicine in the US indicates its practical application. There are many regulatory challenges faced by these systems; however, evidence from systematic reviews confirms the effectiveness of Ayurvedic interventions against type 2 diabetes, osteoarthritis, and stress-related disorders (Schiele et al., 2024). However, safety issues remain among the herbal supplement quality problems, contamination incidents, and labelling inconsistencies (Madhavan, 2017).

In Europe, which has a very uneven terrain, attempts to incorporate any level of Ayurvedic science into mainstream healthcare emanates from Germany and Switzerland with varying intensities. Researchers underpin such developments by demonstrating its effectiveness in conditions such as inflammation and metabolic disorders (Van der Valk, 2017). Usually in Europe, a somewhat strict regulatory framework often marked by the Traditional Herbal Medicinal Products Directive (THMPD) severely limits Ayurvedic Product Availability, and hence its scope, accessibility, and utility.

4.1.2 Comparative insights

Countries with strong research frameworks, such as India and Germany, have been more successful in establishing credibility for Ayurveda. This is because academic institutions, regulatory bodies, and practitioners collaborate to systematically study safety and efficacy in these regions. With limited research and regulations, such as in the Middle East and parts of Africa, ensuring that Ayurvedic principles are consistently applied becomes challenging.

4.2 Challenges and limitations

4.2.1 Lack of uniform regulatory frameworks

The most important obstacle to the globalization of Ayurveda lies in the lack of uniform regulatory standards. While India, for example, has stringent guidelines under the AYUSH Ministry, none of these countries have adopted similar frameworks. The result is variability in quality, safety, and accessibility of Ayurvedic products and practices. For instance, the Dietary Supplement Health and Education Act (DSHEA) has made it possible to sell Ayurvedic supplements in the USA as dietary supplements, and thus is not required to meet the strict clinical trial requirements of pharmaceuticals, which, from a consumer safety perspective, is a grey area (Banerjee et al., 2019).

The European Traditional Herbal Medicinal Products Directive (THMPD) has stringent requirements for the registration and use of herbal medicines in Europe, often acting as a barrier to Ayurvedic products when any historical documentation does not support these or meets traditional preparation standards. Such inconsistency in regulation inhibits the assimilation of Ayurveda into mainstream healthcare systems and its full potential to contribute towards solving chronic health conditions worldwide (Madhavan, 2017).

4.2.2 Need for rigorous clinical trials and standardisation

In addition to this immense popularity, Ayurvedic practices have constantly been rebuked owing to their limited evidence with good quality randomized clinical trials (RCTs). Many such studies on Ayurveda interventions suffer from merely observational data and a minimal respondent base, rendering the findings challenging to generalize. Only a few RCT studies in Ayurveda medicine have been published because they can be funded only at comparatively lower rates; in most instances, the methodology is too large to be adjusted to the present scientific mode of research assessment (Chattopadhyay et al., 2022).

The second pressing issue is standardization. Most Ayurvedic preparations are complex formulations involving more than one herb, and it is difficult to isolate the active principles from such a formulation and study their pharmacodynamics. Different methods of preparation, dosages, and raw material sourcing are additional problems in standardization. The latter raises serious questions regarding consistency and reliability (Patwardhan et al., 2017). Thus, standardization issues are best addressed through consensus among researchers, practitioners, and regulatory agencies in laying down uniform standards and quality assurance mechanisms.

4.2.3 Cultural and perceptual barriers

Various perceptions also prevail regarding Ayurveda in the cultural landscape of acceptance. In countries where evidence-based medicine has traditionally dominated and other approaches are not well understood, Ayurvedic science remains somewhat suspect because it relies on traditional wisdom and holistic ideas in which disease processes are discussed. The perception of mainstream medicine often obstructs an integrative approach to its incorporation into the mainstream practice of healthcare and deprives them of opportunities for funding through well-designed studies (Darker, 2014). Ayurveda faces fewer perceptual barriers in other countries, such as the Middle East, where traditional and spiritual healing is culturally deep-rooted, despite limited institutional support and regulatory oversight.

4.3 Implications for future research

4.3.1 Cross-disciplinary studies

Further studies should focus on cross-disciplinary research approaches, integrating traditional Ayurvedic knowledge with modern scientific inputs. The gap between traditional and contemporary medicine is bridged by direct interactions between Ayurvedic experts, biomedical researchers, and/or pharmacologists. For instance, research into the molecular mechanism of Ayurvedic formulations may provide knowledge for its therapeutic application, which would increase its acceptance in evidence-based medicine (Massey & Kirk, 2015).

4.3.2 Global collaborations

Therefore, global collaborations are significant for advancing research and practice in Ayurveda. Collaboration between Indian institutions and other international organizations, such as the WHO, to exchange knowledge, resources, and expertise can further this. Collaborative research should be planned for large-scale RCTs to establish the safety and efficacy of Ayurvedic interventions across different populations. Such collaborations would also harmonize regulatory standards, ensuring the quality and safety of Ayurvedic products globally (Muralidhara & Rajini 2023).

4.3.3 Innovative methodologies

Therefore, the unique challenges in Ayurveda’s study require new research methodology. For example, adaptive trial designs that allow modification based on intermediate results can help evaluate complex interventions, such as Panchakarma. In addition, including real-world evidence from clinical practice will complement traditional RCTs and make the knowledge of Ayurveda’s impact more comprehensive (Chattopadhyay et al., 2022).

4.3.4 Digital integration and big data analytics

Integrating digital technologies with big data analytics opens up a bright perspective for Ayurveda research. E-health records, wearable devices, and mobile health applications will support the data collection of Ayurvedic treatment outcomes, thus enabling the analysis of large datasets in search of patterns and trends (Chelishcheva, 2023). This approach will also facilitate personalized medicine by leveraging Ayurveda’s focus on individual constitution (Prakriti) in designing interventions based on genetic, environmental, and lifestyle factors (Mukherjee et al., 2017).

4.3.5 Educational and awareness campaigns

Public and professional recognition of any possible benefits that Ayurveda offers and acceptance require better engagement. Public education processes directed at health professionals and policymakers may help clarify misconceptions and determine where to find substantiation for many studies on traditional practices within established evidence profiles. Including Ayurveda curricula in training healthcare service providers goes a long way to develop mainstream acceptance over time of the healthcare systems that the world needs (Krishna et al., 2020).

4.3.6 Focus on chronic and emerging diseases

Future research should focus on areas in which Ayurveda has shown the most significant promise, such as chronic and lifestyle-related diseases. Conditions such as diabetes, arthritis, and mental health disorders, which often have multifactorial causes, align with Ayurveda’s holistic approach. Furthermore, exploring Ayurveda’s potential to address emerging health challenges, such as antimicrobial resistance and long-term COVID-19, might open new avenues for application (Devpura et al., 2021).

Ethics and consent

Ethical approval and consent were not required.